CMS/EIP Fiscal Report Center: 52
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 477 290.500000 10694.2500 36.8133
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 297 967.500000 35723.5000 36.9235
Subtotal (Total Children Is Unduplicated) 611 1260.750000 46417.7500 36.8176
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 2 5.000000 311.0000 62.2000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 4.500000 225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 21 21.750000 1087.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 28 27.000000 675.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 15 17.500000 875.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 15 19.250000 962.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 3.750000 187.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 14 17.500000 875.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 13.500000 675.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 24 43.500000 2175.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.750000 68.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 27 33.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
INTR-T1013-INTERPRETER 5 35.000000 1750.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 73 223.000000 2230.0000 10.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 1 5.000000 357.2000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 8.000000 571.5200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 6 10.500000 388.5000 37.0000
TRAV-TRAVS-Travel by mile 103 3929.000000 1748.0600 0.4449
Subtotal (Total Children Is Unduplicated) 182 4426.250000 15357.7800 3.4697
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Total 5692.000000 62086.5300 10.9077
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Number of Children (Unduplicated) With at Least One Service 669
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Center 52
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 9 7.500000 314.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 534 4376.000000 14614.5300 12615.8100
1903 1308.500000 47157.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2446 5692.000000 62086.5300 12615.8100